Summary

β-blocker and calcium channel blocker toxicity generally present with bradycardia and hypotension. A 69-year-old woman presented
after a suicide attempt with a β-blocker and calcium channel blocker overdose. Her blood pressure was 69/35 mm Hg and her
HR was in the 40s. She was treated with calcium chloride, glucagon, a dextrose–insulin infusion and three vasopressors, but
remained hypotensive. She suffered two cardiac arrests and required a transvenous pacemaker. When all interventions failed,
she was started on a methylene blue infusion for refractory vasodilatory shock which resulted in a dramatic improvement in
her blood pressure. The patient was successfully weaned off all vasopressors and from mechanical ventilation without any end-organ
damage.